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Chapter 20: Minimally Invasive Surgery and Bariatrics

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Which of the following statements correctly identifies a component of the National Institutes of Health (NIH) Consensus Statement on qualification for bariatric surgery?

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(A) Body mass index (BMI) greater than 35 kg/m2 with a medical comorbidity related to morbid obesity or BMI greater than 40 kg/m2

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(B) BMI greater than 35 kg/m2

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(C) Age less than 60

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(D) Significant weight loss with nonsurgical methods such as dieting, exercise, and behavioral modifications

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(A) The NIH Consensus Development Conference Statement summarizes the conclusions obtained following a 2-day conference in March 1991. Several basic patient selection criteria were recommended, including the following: BMI ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 with a minimum of one medical comorbidity related to obesity (e.g., sleep apnea, Pickwickian’s syndrome, diabetes mellitus, joint disease, GERD, and so on), a demonstrated low probability to be successful with nonsurgical weight loss measures, and demonstrated ability to participate and maintain follow-up on a long-term basis.

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The consensus panel did not provide guidelines regarding surgical weight loss treatment of children or adolescents, even subjects with BMI > 40 kg/m2. Several centers perform weight loss surgery on adolescents, and guidelines have been proposed that are similar to the NIH guidelines. These guidelines, however, have not been incorporated into the NIH guidelines. Continued study to include randomized trials is necessary.

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BIBLIOGRAPHY

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Brolin RE., NIH consensus conference. Gastrointestinal surgery for severe obesity. Nutrition. 1996 Jun;12(6):403-4

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Nguyen NT, DeMaria EJ, Hutter MM, eds. The SAGES Manual: A Practical Guide to Bariatric Surgery. New York, NY: Springer; 2008.

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Pratt JS, Lenders CM, Dionne EA, et al. Best practice updates for pediatric/adolescent weight loss surgery. Obesity (Silver Spring) 2009;17(5):901–910.

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Which patient qualifies for bariatric surgery based on NIH guidelines?

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(A) 40-year-old female with no medical comorbidities and a BMI of 38 kg/m2

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(B) 55-year-old male with insulin-dependent diabetes mellitus, a BMI of 38 kg/m2, and failed nonsurgical weight loss techniques for 12 months

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(C) 48-year-old male with BMI of 35 kg/m2 who suffers from arthritis, sleep apnea, and gastroesophageal reflux and has no history of structured weight loss techniques

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(D) 16-year-old female with BMI of 40 kg/m2 with depression and hyperparathyroidism

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(B) The NIH Consensus Development Conference Statement summarizes the conclusions obtained following a 2-day conference in March 1991. Several basic patient selection criteria were recommended, including ...

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